GI Bleeding and Pancreatitis

Question 1

Mortality score for admitted patients with upper GI bleeding

Answer 1

AIMS65

Question 2

Components of the AIMS65 score

Answer 2

Albumin
INR
Mental status (altered)
SBP 
Age (<65)

Question 3

Albumin cut off for AIMS65 score

Answer 3

< 3.0

Question 4

INR cut off for AIMS65 score

Answer 4

> 1.5

Question 5

BP cut off from AIMS65 score

Answer 5

< 90

Question 6

Maximum AIMS65 score and mortality risk

Answer 6

5

100%

Question 7

AIMS65 score of 4 mortality risk

Answer 7

75%

Question 8

AIMS65 score 3 mortality risk

Answer 8

43%

Question 9

Step that comes before sending patient for EGD

Answer 9

Volume resuscitation

Question 10

Time frame for EGD in GI bleeding patient

Answer 10

Within 24 hours (No benefit in any earlier)

SHOCK EXCLUDED IN STUDIES

Question 11

“Benign” GI bleeding endoscopic key word findings

Answer 11

Clean based or flat pigmented spot

Question 12

Transfusion goal in GI bleeding

Answer 12

< 7 UNLESS ACTIVELY BLEEDING

Question 13

Bolus or drip for PPI in GI bleeding?

Answer 13

Bolus (non inferior in studies)

Question 14

Dose of Octreotide for variceal bleeding

Answer 14

50 mcg bolus followed by 50 mcg/hr for 3-5 days after hemostasis

Question 15

Antibiotic class preferred in variceal bleeding

Answer 15

quinolones

Question 16

Banding vs sclerotherapy for variceal bleeding, which is superior?

Answer 16

Banding

Question 17

Tube used in severe upper GI bleeding

Answer 17

Blakemore or Minnesota tube

Question 18

Catastrophic complication of placement of a blakemore tube

Answer 18

Esophageal rupture

Question 19

4 contraindications to TIPS procedure

Answer 19

CHF
Severe PHTN
Systemic infection/sepsis
Severe TR

Question 20

Ligament that anatomically defines upper vs lower GI bleeding

Answer 20

Ligament of treitz

Question 21

Purge preparation routine dosing

Answer 21

4-6L of polyethylene glycol

Question 22

Most sensitive test for lower GI bleeding

Answer 22

Radionucleotide imaging

not great at localization of the bleeding

Question 23

Diagnostic and therapeutic intervention for lower GI bleeding that can’t undergo scope

Answer 23

Angiography (can localize and embolize)

Question 24

Diarrhea definition for C diff

Answer 24

> 3 loose stools in 24 hours

Question 25

Toxin A or B, which strain causes the symptoms in Cdiff?

Answer 25

Toxin B

Question 26

2 Criteria for severe C diff infection

Answer 26

WBC > 15K OR Cr > 1.5

Question 27

3 Criteria for fulminant C diff

Answer 27

Hypotension/Shock Ileus Megacolon

Question 28

Treatment regimen for non-fulminant C diff infection

Answer 28

Vancomycin 125 mg q6h for 10 days OR Fidaxomicin 200 mg BID for 10 days

Question 29

Treatment for fulminant C diff infection

Answer 29

Vancomycin 500 mg q6h | Flagyl 500 mg q8h

Question 30

Discoloration of the sides of the abdomen

Answer 30

Grey turner sign in pancreatitis

Question 31

3 criteria to diagnose acute pancreatitis

Answer 31

Abdominal pain consistent with pancreatitis Amylase or lipase > 3x upper limit Characteristic imaging findings need 2 of the 3

Question 32

BISAP score for pancreatitis components

Answer 32

``` BUN Impaired mental status SIRS Age Pleural effusion ```

Question 33

Score in pancreatitis that can estimate mortality

Answer 33

BISAP score

Question 34

BUN cut off for BISAP score

Answer 34

BUN > 25

Question 35

AGE cut off for BISAP score

Answer 35

Age > 60

Question 36

Are routine antibiotics administered in acute pancreatitis?

Answer 36

No

Question 37

Treatment of choice for infected necrosis in acute pancreatitis

Answer 37

Carbapenem

Question 38

Triglyceride level that can cause acute pancreatitis

Answer 38

> 1000

Question 39

Enteric or parenteral feedings in acute pancreatitis

Answer 39

enteric

Question 40

Bolus or goal directed IV fluids in acute pancreatitis

Answer 40

goal directed